Florida, your insurance coverage just changed

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Question: In Florida, what changes are there to the PIP coverage? I’ve heard a lot of talk about changes in 2013, but I don’t know the details.

Answer: Even with changes to Florida's no-fault insurance, car owners here are still required to purchase $10,000 worth of personal injury protection (PIP) coverage. PIP will continue pay out 80 percent of medical expenses that are found to be necessary and reasonable, regardless of fault.

However, starting in Jan. 1, 2013, there are changes in Florida concerning how quickly you must receive medical treatment for your injuries and who can treat them. How much you can be paid will depend upon your medical condition -- if your injury isn’t declared serious, then you can only receive up to $2,500 in PIP benefits.

Under the revisions to Florida’s no-fault law (Florida Statute 627.736), you must initialize medical services and care within 14 days of the accident in order for to be eligible for benefits. The law is also strict about who can see you for your initial medical treatment.

Starting in 2013, your initial medical care must be:

provided by emergency medical services personnel, or

provided in a hospital, or

in a facility that owns or is wholly owned by a hospital, or

provided by a medical doctor, an osteopath, a dentist, or chiropractor.

For follow-up medical treatment to be covered under your PIP benefits, it must be based on a referral from the approved healthcare professional that provided you the initial medical care. Follow up services may be provided by a:

Hospital

Ambulatory surgery center

Medical doctor

Osteopath

Dentist

Chiropractor

Physician’s assistant

Advanced registered nurse practitioner (ARNP)

Physical therapist

Certain health care clinics

Under the changes to the no-fault coverage, massage therapy and acupuncture won’t be covered, even if an authorized physician prescribes it.

If the appropriate health-care professional determines that you suffered from an emergency medical condition, then you can receive reimbursement for all medical services and care up to your $10,000 PIP limit. If, instead, you’re found to have a non-emergency medical condition, then your PIP benefits are limited to only $2,500.

Florida statute 627.732(16) defines an emergency medical condition as a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain. Without seeking immediate medical attention, your medical condition could result in any of the following:

Serious jeopardy to your health;

Serious impairment to bodily functions;

Serious dysfunction of any bodily organ or part.

A provision in the no-fault law now also allows that after a claim has been made for PIP benefits, an auto insurance company can request that the insured submit to a mental or physical examination by a physician (paid for by the insurer) to verify the initial medical findings.

PIP will continue to pay 100 percent for necessary for reasonable replacement services that may be required due to your injuries and 60 percent of work loss -- up to your limit. Death benefits are capped at $5,000 but are in addition your $10,000 medical and work loss benefits.

All portions of your Florida PIP, except the death benefit, will continue to be subjected to the deductible you selected.

Why the changes?

The Florida Office of the Insurance Regulation (FLOIR) says that the state established a no-fault system of car insurance to speed up payment for injured drivers and limit lawsuits. However, in recent years the amount of motor vehicle accidents has remained relatively the same in Florida but PIP claims have skyrocketed – nearly 50 percent of fraud investigations are in regards to PIP.

Lawmakers also hoped the PIP reforms would lower car insurance rates in Florida, but thus far the rate filings show the savings to be minimal at best. The state’s insurance commissioner says that it appears the PIP revisions are mitigating rate increases instead of producing rate reductions.

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